Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy.
Am J Nephrol. 2013;37(3):255-63. doi: 10.1159/000348566. Epub 2013 Mar 13.
Renal biopsy procedure in patients with chronic renal failure (CRF) may represent a valid tool to help clinicians in clinical practice. However, the use of this invasive method in CRF is variable and it reflects the hospital biopsy policy.
To better define the CRF-related histological patterns and to assess the clinical utility of this procedure in this extensive group, we analyzed biopsy records of 1,185 CRF patients living in a large area of north-east Italy from 1998 to 2010.
Data analysis showed that, although the biopsy incidence rate and the histological features were unchanged, the mean age of our CRF patients increased during the study period (R(2) = 0.42, p < 0.01). Primary and secondary glomerulonephritis (SGNs) were the main histological presentations (53.9 and 23%, respectively). SGNs were over-diagnosed in females. Leading histological types were immunoglobulin A nephropathy (22%), focal segmental glomerulosclerosis (12.4%), membranous glomerulonephritis (MGN, 7.5%) and nephroangiosclerosis (7.3%). These forms were also highly frequent in CRF patients with elevated proteinuria and moderate/severe renal damage. Elderly patients were primarily affected by MGN. After biopsy, 49.5% of CRF patients with and 34.1% without nephrotic syndrome received immunosuppression therapy.
This study demonstrated that renal biopsy in CRF patients, regardless of age and glomerular filtration rates, is safe and essential to achieve a correct diagnosis and to commence the correct therapy. Additionally, it revealed that, even in patients with severe renal damage, it is possible to perform an accurate histological diagnosis and, interestingly, end-stage kidney disease seems not to be the primary form.
在慢性肾衰竭（CRF）患者中进行肾活检可能是一种有助于临床医生在临床实践中的有效工具。然而，这种有创方法在 CRF 中的应用是多变的，这反映了医院的活检政策。
为了更好地定义与 CRF 相关的组织学模式，并评估该程序在这个广泛的群体中的临床实用性，我们分析了 1998 年至 2010 年间生活在意大利东北部一个大区的 1185 例 CRF 患者的活检记录。
数据分析显示，尽管活检发生率和组织学特征没有改变，但在研究期间，我们的 CRF 患者的平均年龄增加了（R²=0.42，p<0.01）。原发性和继发性肾小球肾炎（SGNs）是主要的组织学表现（分别为 53.9%和 23%）。女性中 SGN 过度诊断。主要的组织学类型为免疫球蛋白 A 肾病（22%）、局灶节段性肾小球硬化症（FSGS，12.4%）、膜性肾小球肾炎（MGN，7.5%）和肾血管硬化症（7.3%）。这些形式在伴有蛋白尿升高和中重度肾功能损害的 CRF 患者中也非常常见。老年患者主要受 MGN 影响。肾活检后，49.5%的有肾病综合征的 CRF 患者和 34.1%的无肾病综合征的 CRF 患者接受了免疫抑制治疗。
本研究表明，无论年龄和肾小球滤过率如何，对 CRF 患者进行肾活检都是安全且必要的，可以实现正确的诊断并开始正确的治疗。此外，研究结果还表明，即使在肾功能严重受损的患者中，也可以进行准确的组织学诊断，有趣的是，终末期肾病似乎不是主要形式。
